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An Interactive Individualized Intervention to Promote Behavioral Change to Increase Personal Well-Being in US Surgeons
Abstract
Evaluate the utility of a computer-based, interactive, and individualized intervention for promoting well-being in US surgeons.
Distress and burnout are common among US surgeons. Surgeons experiencing distress are unlikely to seek help on their own initiative. A belief that distress and burnout are a normal part of being a physician and lack of awareness of distress level relative to colleagues may contribute to this problem.
Surgeons who were members of the American College of Surgeons were invited to participate in an intervention study. Participating surgeons completed a 3-step, interactive, electronic intervention. First, surgeons subjectively assessed their well-being relative to colleagues. Second, surgeons completed the 7-item Mayo Clinic Physician Well-Being Index and received objective, individualized feedback about their well-being relative to national physician norms. Third, surgeons evaluated the usefulness of the feedback and whether they intended to make specific changes as a result.
A total of 1150 US surgeons volunteered to participate in the study. Surgeons' subjective assessment of their well-being relative to colleagues was poor. A majority of surgeons (89.2%) believed that their well-being was at or above average, including 70.5% with scores in the bottom 30% relative to national norms. After receiving objective, individualized feedback based on the Mayo Clinic Physician Well-Being Index score, 46.6% of surgeons indicated that they intended to make specific changes as a result. Surgeons with lower well-being scores were more likely to make changes in each dimension assessed (all Ps < 0.001).
US surgeons do not reliably calibrate their level of distress. After self-assessment and individualized feedback using the Mayo Clinic Physician Well-Being Index, half of participating surgeons reported that they were contemplating behavioral changes to improve personal well-being.
... The primary goal of all 17 interventions was to reduce or prevent SRDs and thus to change behaviour. Informing HCWs about SRDs was part of the intervention goal; some studies gave information during training (Arrigoni et al. 2015), digitally (Blake et al. 2020;Ketelaar et al. 2013a, b;Shanafelt et al. 2014;Weiner et al. 2020), during discussion sessions (d'Ettorre and Greco 2015; Di Tecco et al. 2020;Niks et al. 2013Niks et al. , 2018Uchiyama et al. 2013) or by the occupational physician (Gartner et al. 2011(Gartner et al. , 2013Ketelaar et al. 2013aKetelaar et al. , b, 2014aRuitenburg et al. 2015Ruitenburg et al. , 2016. Through the giving of information, in all interventions HCWs were encouraged to take action to protect their health, but they could decide this for themselves, or they could decide not to do anything about it. ...
... The intervention deliverer varied between the studies. In seven studies, intervention deliverers were the researchers of the study (Arrigoni et al. (Gartner et al. 2011(Gartner et al. , 2013Ketelaar et al. 2013aKetelaar et al. , b, 2014a, support network and job-related investments (Le Blanc et al. 2007), job demands and job resources (Niks et al. 2013(Niks et al. , 2018 and career satisfaction and meaning of work (Shanafelt et al. 2014). In 15 interventions (Arrigoni Blake et al. 2020;Ericson-Lidman and Ahlin 2017;Gartner et al. 2011Gartner et al. , 2013Gartner et al. , 2016Gartner et al. , 2018Havermans et al. 2018;Isaksson Ro et al. 2010;Ketelaar et al. 2013aKetelaar et al. , b, 2014aLe Blanc et al. 2007;Moll et al. 2015;Niks et al. 2013;Ruitenburg et al. 2015;Schneider et al. 2019;Shanafelt et al. 2014;Uchiyama et al. 2013;Weiner et al. 2020), the questionnaires were self-administered, in 1 it was conducted by interviews (d'Ettorre and Greco 2015) and in another one also accompanied with objective data (Di Tecco et al. 2020). ...
... In seven studies, intervention deliverers were the researchers of the study (Arrigoni et al. (Gartner et al. 2011(Gartner et al. , 2013Ketelaar et al. 2013aKetelaar et al. , b, 2014a, support network and job-related investments (Le Blanc et al. 2007), job demands and job resources (Niks et al. 2013(Niks et al. , 2018 and career satisfaction and meaning of work (Shanafelt et al. 2014). In 15 interventions (Arrigoni Blake et al. 2020;Ericson-Lidman and Ahlin 2017;Gartner et al. 2011Gartner et al. , 2013Gartner et al. , 2016Gartner et al. , 2018Havermans et al. 2018;Isaksson Ro et al. 2010;Ketelaar et al. 2013aKetelaar et al. , b, 2014aLe Blanc et al. 2007;Moll et al. 2015;Niks et al. 2013;Ruitenburg et al. 2015;Schneider et al. 2019;Shanafelt et al. 2014;Uchiyama et al. 2013;Weiner et al. 2020), the questionnaires were self-administered, in 1 it was conducted by interviews (d'Ettorre and Greco 2015) and in another one also accompanied with objective data (Di Tecco et al. 2020). ...
Purposes
Healthcare workers are at risk of stress-related disorders. Risk communication can be an effective preventive health measure for some health risks, but is not yet common in the prevention of stress-related disorders in an occupational healthcare setting. The overall aim is to examine whether risk communication was part of interventions aimed at the prevention of stress-related disorders in healthcare workers.
Method
We performed a scoping review using the framework of Arksey and O’Malley. We searched in Medline, Web of Science and PsychInfo for studies reporting on preventive interventions of stress-related disorders in healthcare workers between 2005 and December 2020. Studies were included when the intervention reported on at least one element of risk communication and one goal. We predefined four elements of risk communication: risk perception, communication of early stress symptoms, risk factors and prevention; and three goals: inform, stimulate informed decision-making and motivate action.
Results
We included 23 studies that described 17 interventions. None of the included interventions were primarily developed as risk communication interventions, but all addressed the goals. Two interventions used all four elements of risk communication. The prominent mode of delivery was face to face, mostly delivered by researchers. Early stress symptoms and risk factors were measured by surveys.
Conclusions
Risk communication on risk factors and early signs of stress-related disorders is not that well studied and evaluated in an occupational healthcare setting. Overall, the content of the communication was not based on the risk perception of the healthcare workers, which limited the likelihood of them taking action.
... MedEd Solutions collected and disseminated de-identified aggregate data to designated organizational administrators through a secure website portal. Demographic information was collected by MedEd Solutions and stored confidentially for the purpose of creating a user profile [21]. During the registration process to access the Well-Being Index, physicians identified the frequency at which they wanted to perform ongoing re-assessments. ...
... At the pre-selected interval, individuals were prompted to voluntarily re-assess using the email address provided during their initial registration. Re-assessment is promoted within the instrument due to results in previous studies linking physician use of the tool with positive behavioral intention to improve their personal well-being [21]. ...
... Workplace happiness has shifted post-pandemic, with decreases in happiness and increases in distress reported since last year [7]. A study of US and international physicians during the Coronavirus pandemic stated 64% of US physicians report self-perceived increased levels of burnout [21]. Data from this study indicated 30.08% of physicians had a high distress score (>3.0) upon assessment over the 6-month period. ...
Introduction: Physician burnout and interventions to decrease physician burnout on organizational and individual levels have been theorized and implemented. The Coronavirus pandemic has increased the need to continue physician burnout assessment and increase wellness programming. Few studies have had the opportunity to address physician wellness amidst the Coronavirus pandemic using the strategy of multi-dimensional interventions. The purpose of this study is to document interventions to reduce burnout and stress among physicians during the Coronavirus pandemic while assessing overall physician distress and well-being. Methods: A cohort study of 304 pediatric physicians at a large healthcare organization in the United States was designed to measure distress in physicians using the Well-Being Index. Participation was voluntary. A third-party collected and disseminated de-identified aggregate data through a secure website portal. Organizational and individual wellness initiatives were introduced to the cohort population and voluntary participation tracked. Results: 145 (48%) Well-Being Index assessments were completed between March 16 and September 30, 2020. Mean distress over the 6-month period was 1.22, with high distress indicated by a score greater than 3.0. Monthly averages show a 111.5% decrease in distress scores during the time period. Over 91% of respondents reported feeling “somewhat” or “very supported” by the organization, and these respondents had overall low mean distress scores. Conclusion: Overall, the cohort population experienced decreased distress levels at program initiation and during the observation period compared to national physician distress data. Contributing factors may be participation in various organizational and individual interventions to target well-being, perceived support from the organization, or regional implications of the Coronavirus pandemic on population health.
... Women surgeons face unique challenges with respect to family responsibilities. Multiple large studies have shown that female surgeons spend more time childrearing [90], are more likely to experience a conflict between work and home duties, are more likely to believe that childrearing had slowed their career advancement, and are less likely to have a spouse who is a homemaker compared to their male counterparts. Those who experienced such work-home conflicts were less likely to feel they had enough time for their personal and family life and had significantly higher rates of burnout. ...
... The WBI was then tested in physicians, residents, and a second cohort of medical students to assess its efficacy in detecting distress and associated negative outcomes [10,88,89]. In a sample of over 2500 medical students and 7500 physicians, a score of ≥4 was both sensitive and specific for low mental QOL, suicidal ideation (SI), and intent to quit [88,90]. In the physician sample, a score of ≥4 was also associated with decreased career satisfaction, fatigue, and increased self-reported medical errors [91]. ...
... In a sample of 1700 residents, a score of ≥5 was sensitive and specific for low mental QOL and increased the likelihood of fatigue, suicidal ideation, and self-reported medical error [10]. With the support of the American College of Surgeons (ACS), the PWBI was then used in a surgery-specific intervention designed to assess surgeon wellbeing relative US physician norms, provide individualized feedback and education promoting health and self-care, and facilitate behavioral changes favoring wellbeing [90]. Findings demonstrated poor self-assessment of wellbeing in surgeons relative to other colleagues with ~70% of surgeons identifying themselves as having average or above average wellbeing, while their PWBI scores ranked in the bottom 30% of the population. ...
The development and properties of the tools used to establish and measure burnout, wellbeing, and traits associated with wellbeing
... Although 59% of schools reported assessing student well-being, only 26% of schools provided students access to self-assessment tools that would provide them with insight into their own level of well-being. 41 In terms of structural approaches, nearly 75% of schools used pass/fail grading during the preclinical years, and 81% used learning communities designed to promote social support and mentorship and address stressors (e.g., ethical dilemmas, career choice). ...
... Experienced physicians struggle to accurately selfassess their level of well-being, which contributes to a lack of timely help seeking. 41 Providing individualized feedback on well-being helps promote behavior change and help seeking. 41,52 Like residency programs, 53 medical schools should consider providing access to and encouraging the iterative use of self-assessment tools to improve self-awareness and identify areas for improvement in the context of well-being. ...
... 41 Providing individualized feedback on well-being helps promote behavior change and help seeking. 41,52 Like residency programs, 53 medical schools should consider providing access to and encouraging the iterative use of self-assessment tools to improve self-awareness and identify areas for improvement in the context of well-being. ...
Purpose: To describe the breadth of strategies U.S. medical schools use to promote medical student well-being.
Method: In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities.
Results: Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16, 81%). These sessions were held at least monthly (12/16, 75%), and there was a combination of optional and mandatory attendance (9/16, 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27, 22%). Most schools relied on participation rates (26/27, 96%) and student satisfaction (22/27, 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27, 82%), a student well-being committee (22/27, 82%), pass/fail grading in preclinical courses (20/27, 74%), and the presence of learning communities (22/27, 81%).
Conclusions: Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.
... Although burnout affects workers across a broad range of professional disciplines, it has become a problem of epidemic proportions within the field of medicine [11]. Prevalence estimates among physicians range between 37.9% [13] and 80.5% [14] compared with rates between 2% and 27.8% reported for the general working population [9,13]. Of particular concern is the increasing frequency of burnout experiences emerging during the early stages of medical training, with a global prevalence of approximately 44.2% among medical students [15]. ...
... Although burnout affects workers across a broad range of professional disciplines, it has become a problem of epidemic proportions within the field of medicine [11]. Prevalence estimates among physicians range between 37.9% [13] and 80.5% [14] compared with rates between 2% and 27.8% reported for the general working population [9,13]. Of particular concern is the increasing frequency of burnout experiences emerging during the early stages of medical training, with a global prevalence of approximately 44.2% among medical students [15]. ...
Background
Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches.
Objective
This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated.
Methods
In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants’ identified PF training needs at each log-in or nonindividualized.
Results
Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group.
Conclusions
The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions.
Trial Registration
Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx
International Registered Report Identifier (IRRID)
PRR1-10.2196/32992
... Using the cut-off points, the instruments have been reported to identify not only physicians and workers at distress, but also those at risk for adverse consequences (i.e., 2 fold higher risk of reporting a recent medical error, 2 fold higher risk of suicidal ideation, and 5 fold higher risk of burnout in those physicians with EPWBI ≥ 3, and 2.1 fold higher risk of suicidal ideation, 2.9 fold higher risk of burnout, and 2.3 fold higher risk of poor overall quality of life for workers with GWWBI ≥ 2). We used the respective cut-off points according to the kind of participants in our study (Dyrbye, Satele, & Shanafelt, 2016;Shanafelt et al., 2014a), and c. The TOP-8, a short PTSD inventory with eight questions that evaluates and categorizes into four groups the presence of symptoms according to DSM-5 diagnostic criteria: risk free (< 5 points), mild risk (5-17 points), moderate risk (18-25 points), and severe risk with probability of comorbidities (26-36 points). ...
... Anyway, even mild cases detection offers the opportunity for early intervention, so we found it useful to report the data. Well-being risk (considering well-being as an opposite to burnout) coincides with the prevalence reported on other health workers (i.e., 24%) in the U.S.A. Surgeons (Shanafelt et al., 2014a), 34% in oncologists (Shanafelt et al., 2014b), and the general prevalence of burnout syndrome before the pandemic (44%) (Kane, 2019). ...
Introduction. In Mexico, a National Mental Health Strategy was implemented to identify and attend the mental health repercussions of the COVID-19 pandemic. It included the creation of five virtual clinics for health workers, being the Burnout, Post-traumatic Stress, and Compassion Fatigue clinic one of them.
Objective. To describe the basal sociodemographic and psychological characteristics of health workers attending online mindfulness sessions as part of the treatment of the aforementioned clinic. Method. This is a cross-sectional report part of a major nationwide and longitudinal project. All attendants responded to digital sociodemographics and COVID-19 questionnaires, the Extended Physician Well-Being Index (EPWBI), and the Post-traumatic Stress Disorder (PTSD) TOP-8 index. Results.
Of the 507 health workers that participated, 70.02% of them were at risk of burnout according to the Extended Well-Being Index and 57.31, 7.91 and 2.77% had a mild, moderate, and severe risk of PTSD, respectively.
The most affected were the female health workers, from metropolitan or central areas of
the country, and those diagnosed with COVID-19 or exposed to a person with the diagnosis.
Discussion and conclusion. Mexican health workers attending mindfulness sessions presented high frequencies of PTSD symptoms and burnout. Female workers at urban hospitals could be at special risk for developing PTSD or Well-ness alterations, and thus,
they must be cared for closely, particularly those having direct contact with COVID 19 positive persons. The early participation in mental health strategies might lessen the immediate and long-term pandemic effects.
... We have previously reviewed instrument recommendations, but measurement should occur at both the individual and organizational level [91]. Anonymous online tools exist, allowing individual physicians to privately gauge their level of burnout against normative physician samples [125][126][127]. These tools have been shown to prompt reflection and possible action steps to address burnout in large groups of physicians [127]. ...
... Anonymous online tools exist, allowing individual physicians to privately gauge their level of burnout against normative physician samples [125][126][127]. These tools have been shown to prompt reflection and possible action steps to address burnout in large groups of physicians [127]. At the organizational level, burnout assessment should be considered part of the "dashboard" of tracked institutional performance measures, quality indicators, and leadership performance [49,91,128]. ...
Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the health care workforce, costs, and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients, and health care organizations and systems. Drivers of this epidemic are largely rooted within health care organizations and systems, and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures, and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally-developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually-focused solutions such as mindfulness-based stress reduction and small-group programs to promote community, connectedness, and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both health care systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfill its mission for patients and for public health, all stakeholders in health care delivery must work together to develop and implement effective remedies for physician burnout.
... We obtained mean number of annual deaths by age, gender, and type of disease. The gender-specific remaining life-expectancy at the age of death was calculated based on the 2020 Iran lifetable from World Health Organization [23], and subsequently SEYLL for each disease was calculated by the sum of the two obtained gender-specific SEYLL for the type of disease. Then, the calculated SEYLL was multiplied by gross domestic production (GDP) per capita for Iran, which is defined by World Bank [24], to estimate the total economic burden of premature mortality for each disease. ...
Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries.
Methods
Patients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient.
Results
The cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn’s disease, n = 72). The mean annual costs per patient were 1077 US$ (95% CI 900–1253), and 1608 (95% CI 1256, 1960) for the patients with ulcerative colitis and Crohn’s disease, respectively. Of the total costs, 58% and 63% were in terms of the indirect costs for the patients with ulcerative colitis and Crohn’s disease, respectively. The cost of illness for country was found to be 22,331,079 US$ and 15,183,678 US$ for patients with ulcerative colitis and Crohn’s disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn’s disease, respectively.
Conclusion
The medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD’s economic burden in Iran.
... Terwijl zorgmedewerkers bij stressgerelateerde aandoeningen andere ideeën kunnen hebben die hun risicoperceptie beïnvloeden. Zo percipieerden artsen dat stress bij het werk hoort (Shanafelt et al., 2014) hetgeen een reden kan zijn waarom ze niet op tijd actie ondernemen om stressklachten aan te pakken. Indien de bedrijfsarts en andere arboprofessionals zodanig communiceren dat hun communicatie meer aansluit bij de kennis en attitudes van de doelgroep, dan sluit de communicatie beter aan bij de risicoperceptie van de doelgroep en mogelijk worden ze gestimuleerd om actie te ondernemen om hun gezondheid te beschermen. ...
Een preventieve maatregel die kan bijdragen aan het reduceren en/of voorkomen van stressgerelateerde aan-doeningen bij zorgmedewerkers is risicocommunicatie. Risicocommunicatie gaat over oorzaken, gevolgen en preventieve maatregelen van gezondheidsrisico's en heeft drie doelen: informeren, geïnformeerde besluit-vorming stimuleren en motiveren tot actie. Effectieve risicocommunicatie betekent dat de doelgroep de risico-informatie begrijpt en een weloverwogen beslissing kan nemen om de risico's voor gezondheid te reduceren. Een belangrijk element van risicocommunicatie is risicoperceptie, dat wil zeggen de manier waarop mensen over gezondheidsrisico's nadenken, deze interpreteren en beoordelen (Fischhoff, 2013; Morgan, Fischhoff, Bostrom & Atman, 2001). Factoren als kennis, ervaringen, waarden, attitudes en emoties over gezondheidsrisico's hebben invloed op hoe mensen risico's inschatten, of zij risico's serieus nemen en of zij er vervolgens iets mee doen. Mensen met lage risicoperceptie zijn bijvoorbeeld minder snel geneigd om actie te onder nemen om hun gezondheid te beschermen (Wachinger, Renn, Begg & Kuhlicke, 2013). Vaak zijn er verschillen tussen hoe verschillende doelgroepen gezondheidsrisico's begrijpen en beoordelen (risicoperceptie). Bijvoorbeeld, bedrijfsartsen en andere arboprofessionals beoordelen overmatige stress als slecht voor de gezondheid. Terwijl zorgmedewerkers bij stressgerelateerde aandoeningen andere ideeën kunnen hebben die hun risicoperceptie beïnvloeden. Zo percipieerden artsen dat stress bij het werk hoort (Shanafelt et al., 2014) hetgeen een reden kan zijn waarom ze niet op tijd actie ondernemen om stressklachten aan te pakken. Indien de bedrijfsarts en andere arboprofessionals zodanig communiceren dat hun communicatie meer aansluit bij de kennis en attitudes van de doelgroep, dan sluit de communicatie beter aan bij de risicoperceptie van de doelgroep en mogelijk worden ze gestimuleerd om actie te ondernemen om hun gezondheid te beschermen.
... According to Shanafelt et al. [36], use of the PWBI could enhance the ability of health professionals to become aware of their level of distress and contemplate behavioral changes to improve their well-being, which is also an important prerequisite for seeking and maintaining mental health treatment, if required. In this respect, the present study could have a heuristic to improve the evaluation of distress among Spanish-speaking healthcare professionals and therefore the treatment and alleviation of mental health consequences and ultimately the improvement of their well-being. ...
Background:
The Physician Well-Being Index (PWBI) is a brief, valid, reliable self-assessment instrument to identify health professionals' distress and those in need of an intervention.
Objective:
to evaluate the construct, predictive validity (of depression, suicidal ideation, insomnia, and generalized anxiety), and internal consistency of the 7-item Spanish version of the PWBI (PWBI-S).
Methods:
out of a national population of approximately 1 million Mexican healthcare professionals, a sample of 3506 subjects (42.0% physicians, 28.7% nurses and 29.3% psychologists) completed an online survey between 17 April and 7 May 2020, at the time of the COVID-19 case cluster transmission scenario in Mexico.
Results:
In the three sub-samples, PWBI-S's Confirmatory factor analyses (adding residual covariances) exhibited adequate goodness of fit indices for the PWBS original unidimensional model. Overall Cronbach's alphas were 0.89 for physicians, 0.90 for nurses, and 0.86 for psychologists. Univariate logistic regression models showed that a cutoff point of 3 on the total score of the PWBI-S was generally related to the presence of depression, suicidal ideation, and insomnia, but not with generalized anxiety among nurses and psychologists. When trying with a cutoff point of 3, a relationship with GA was shown in psychologists, but not in nurses.
Conclusions:
our findings suggest that PWBI-S is a valid, reliable measure for clinical and research purposes in the field.
... vacation time, physician wellness programs, workplace support, job control, etc.) have also been identified. 3,17,41,42 Traditionally, perspectives on this issue have focused on the negative aspects of physician wellness (i.e. burnout). ...
Aims
Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.
Methods
A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.
Results
A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a ‘at-risk’ or ‘burnout’ score.
Conclusions
The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932–939.
... Scores at or above abnormal risk thresholds (≥3 for physicians and ≥ 4 for APPs) are associated with increased burnout, depression, decreased quality of life, and fatigue. WBI scores correlate other significant events such as medical error and intent to leave the job or profession [27][28][29][30][31]. ...
Abstract Background While COVID-19 has had far-reaching consequences on society and health care providers, there is a paucity of research exploring frontline emergency medicine (EM) provider wellness over the course of a pandemic. The objective of this study was to assess the well-being, resilience, burnout, and wellness factors and needs of EM physicians and advanced practice providers (e.g., nurse practitioners and physician assistants; APPs) during the initial phase of the COVID-19 pandemic. Methods A descriptive, prospective, cohort survey study of EM physicians and APPs was performed across ten emergency departments in a single state, including academic and community settings. Participants were recruited via email to complete four weekly, voluntary, anonymous questionnaires comprised of customized and validated tools for assessing wellness (Well Being Index), burnout (Physician Work Life Study item), and resilience (Brief Resilience Scale) during the initial acceleration phase of COVID-19. Univariate and multivariate analysis with Chi-squared, Fisher’s Exact, and logistic regression was performed. Results Of 213 eligible participants, response rates ranged from 31 to 53% over four weeks. Women comprised 54 to 60% of responses. Nonrespondent characteristics were similar to respondents. Concern for personal safety decreased from 85 to 61% (p
... Feedback about level of burnout relative to physician peers may enhance intention to change behavior. 144 Coaching and mentoring approaches have been advocated 68,[145][146][147] and documented to be effective in reducing burnout. 134 Learning communities, 136 group support, confidential peer support networks, and professional support are needed to facilitate more intensive intervention for physicians with clinical levels of distress and impairment. ...
Physician burnout is common across specialties and largely driven by demands of the current health care industry. However, the obvious need for systems change does not address the unavoidable impact of providing care to those who suffer. An intentional, developmental, longitudinal approach to resiliency training would not distract from fixing a broken system or blame physicians for their distress. Existing models and approaches to resilience training are promising but limited in duration, scope, and depth. We call for and describe a career-long model, introduced early in undergraduate medical training, extending into graduate medical education, and integrated throughout professional training and continuing medical education, in intrapersonal and interpersonal skills that help physicians cope with the emotional, social, and physical impact of care provision.
... WBI scores correlate other signi cant events such as medical error and intent to leave the job or profession. [28][29][30][31][32] Physician Work Life Study (PWLS) burnout item is a validated tool asking participants to rate their level of selfde ned burnout (1 = "I enjoy my work"; 5 = "I am completely burned out"). Scores were dichotomized (1 or 2 = no burnout; 3 to 5 = burnout symptoms present). ...
Background: While the coronavirus (COVID-19) has had far-reaching consequences on society and health care providers, there is a paucity of research exploring emergency medicine (EM) provider wellness over the course of a pandemic. The objective of this study was to assess the well-being, resilience, burnout, and wellness factors and needs of EM physicians and advanced practice providers (APPs) during the initial phase of the COVID-19 pandemic.
Methods: A longitudinal, descriptive, prospective cohort survey study of 213 EM physicians and APPs was performed across ten emergency departments in a single state, including academic and community settings. Participants were recruited via email to complete four weekly, voluntary, anonymous questionnaires comprised of customized and validated tools for assessing wellness (Well Being Index), burnout (Physician Work Life Study item), and resilience (Brief Resilience Scale) during the initial acceleration phase of COVID-19. Univariate and multivariate analysis with Chi-squared, Fisher’s Exact, and logistic regression was performed.
Results: Of 213 eligible participants, response rates ranged from 31 to 53% over four weeks. Women comprised 54 to 60% of responses. Nonrespondent characteristics were similar to respondents. Concern for personal safety decreased from 85% to 61% (p<0.001). Impact on basic self-care declined from 66% to 32% (p<0.001). Symptoms of stress, anxiety or fear was initially 83% and reduced to 66% (p=0.009). Reported strain on relationships and feelings of isolation affected >50% of respondents initially without significant change (p=0.05 and p=0.30 respectively). Women were nearly twice as likely to report feelings of isolation as men (OR 1.95; 95%CI 1.82-5.88). Working part-time carried twice the risk of burnout (OR, 2.45; 95% CI, 1.10-5.47). Baseline resilience was normal to high. Provider well-being improved over the four-weeks (30% to 14%; p=0.01), but burnout did not significantly change (30% to 22%; p=0.39).
Conclusion: This survey of frontline EM providers during the initial surge of COVID-19 found that despite being a resilient group, the majority experienced stress, anxiety, fear, and concerns about personal safety due to COVID-19, with many at risk for burnout. The sustained impact of the pandemic on EM provider wellness deserves further investigation to guide targeted interventions.
... This could also create further opportunities to discuss stress and vulnerability, to create a shared language across different levels of the organisation, thereby potentially contributing to destigmatisation of vulnerability (see Processes leading to mental ill-health in doctors) and connectedness in the workplace (see Reducing mental ill-health: groups, belonging and relationality). Sharing the evaluation results with the workforce may also 'provide useful information both to those who are doing well (affirmation and reassurance) and encourage behavioural change to those who are struggling', 211 as it may at the same time contribute to normalise vulnerability and convey the positive message that doctors can experience and overcome difficulties. ...
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research ; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
... 52,64 Physicians who are able to engage in regular self-care, such as ensuring adequate physical health, sleep, nutrition, and exercise, consistently have lower rates of burnout. [65][66][67][68][69][70] Although scheduling can be a challenge, regular exercise improves physician wellness. 71,72 Incentivized exercise programs, however, have not been shown to improve physician wellness. ...
Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.
... Burnout has individual, social, and societal consequ ences. 1,3,41,42 In addition to causing well-described mental and physical conditions for individual oncologists, [8][9][10] burnout has been shown to negatively impact patient care, 11,12 lead to higher numbers of medical errors, diminish empathy, 43 and decrease patient satisfaction. 31,44 It can also lead to attrition among oncologists, 13,14 thus worsening workforce shortages and further perpetuating workplace demands. ...
PURPOSE
Oncologists and fellows in hematology/oncology (HO) training programs report high levels of burnout. The Accreditation Council for Graduate Medical Education requires accredited programs to have a mechanism to foster well-being among fellows.
METHODS
Through an iterative process involving a multidisciplinary committee, we created a 3-year longitudinal Art of Oncology (AOO) curriculum intended to address burnout and foster solidary among HO fellows. Sessions used narratives to promote the formation of a shared mental model through discussion of the mutual experience of caring for patients with cancer. We tested the feasibility, acceptability, and initial effectiveness of implementing the curriculum into traditional didactic lectures as a pilot intervention from 2018 to 2019. Eight sessions were completed.
RESULTS
Sixteen fellows participated. Most were married (63%) and planned on pursuing careers in academic medicine (75%). The sample was racially and ethnically diverse (31% minority representation). Thirty-eight percent of fellows reported burnout symptoms. AOO sessions had higher attendance than didactic lectures ( P = .04). Of 14 fellows who completed all follow-up assessments (87.5% response rate), 93% (13 of 14 fellows) felt the sessions were very or somewhat helpful and that sessions improved solidarity. Preparedness in managing work-life balance significantly improved (paired t test, mean difference, 0.53; P = .04). Measured levels of burnout did not significantly improve from baseline (mean difference, −0.133; P = .67). Work-life balance was associated with burnout on multivariable analysis (coefficient, 0.40; P = .03).
CONCLUSION
The implementation of a dedicated AOO curriculum is feasible and viewed as helpful by HO fellows. Larger studies are needed to assess the efficacy of this curricular intervention.
... Short validated tools to assess physician wellbeing across a variety of dimensions are publically available and could be used for this purpose. 37,[68][69][70] These tools also have national benchmarks for physicians by specialty and can also allow a practice to understand how their physicians compare with like specialists nationally. ...
Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.
... burnout among HCPs (e.g., nurses, physicians, health aides, social workers, counselors, therapists) and the MBI-General Survey version for others working in jobs such as customer service, management, and most other professions. Instruments designed to measure multiple dimensions of well-being (burnout, stress, worklife integration, meaning/purpose in work) specifically for physicians have also been developed [88][89][90][91][92][93] and validated [87]. These instruments have also proved useful for workers in other fields [88], and studies to establish national benchmarks for nurses, nurse practitioners, and physician assistants are ongoing. ...
Throughout the career of a physician, they are subjected to long working hours, high stress, life and death situations, risk of malpractice, significant financial debt, and an increasing bureaucratic load. This, in turn, has led to significant rates of burnout and potential suicidal ideation. Suicide prevalence has increased roughly 30% over the past 2 decades, with surgeon suicide rates reaching as high as 3x that of the general cohort. Orthopedic surgeons are most severely affected, composing 28.2% of physician suicides and seeing one third of their suicides from 2003 to 2017 occurring in the last 2 years alone. We provide the latest data and the current trends in orthopedic burnout and suicide rates, delve into the possible inciting factors driving their increase, and provide recommendations to identify their early signs and mitigate progression.
Objectives:
Major clinical incidents can impact healthcare professionals involved. This is of particular relevance in surgery, the operating room being a high-risk zone for complications, however there is little available data on how surgeons may be affected. This study examined the impact of surgical complications on surgeon traumatic stress levels, emotional state, job performance and coping strategies.
Methods:
A questionnaire to evaluate the impact of surgical complications on surgeon traumatic stress levels, emotional state and job performance was developed by our team and communicated via an online link, to gynecological surgeons.
Results:
72 gynecologic surgeons completed the questionnaire. Five percent had a Peritraumatic Distress Inventory (PDI) score ≥15, revealing a high stress level, and 12% had an Impact of Event Scale Revised (IES-R) score ≥36, indicating acute traumatic stress. Our results showed that following surgical incidents, surgeons receive support primarily from another surgical team member and that surgical practice may be impacted, leading in some cases to detrimental effects on patient care; notably reduced radicality in some surgical procedures.
Conclusion:
Surgeons may experience acute traumatic stress after serious surgical complications. Increased awareness of the negative consequences on surgeon emotional well-being is required, as well as improved access to support mechanisms.
Background: Physician burnout has been identified as a significant occupational hazard for decades. Burnout prevention may target individual and workplace environment factors; however, a gold standard approach to prevention has yet to be established. Components for Enhancing Clinician Experience and Reducing Trauma (CE-CERT) is both a practice and peer supervision model for promoting wellness among helping professionals. This study sought to explore the experiences of a group of attending physicians at a mid-size pediatric residency program in an urban free-standing children’s hospital as they learned and implemented CE-CERT.
Methods: A total of seven attending physicians participated in CE-CERT during the academic year between 2020 and 2021. Semi-structured interviews were conducted with five of the seven participants (71%) after completion of the program to explore their experiences with CE-CERT in their personal and professional lives. Through constructivist grounded theory methods, attending physician experiences with CE-CERT were systematically analyzed.
Results: Rigorous analysis revealed six common themes around the attending experiences with the CE-CERT model in their personal and professional lives. The six themes were as follows: 1) It’s given me a framework , 2) It’s given me insight , 3) Taking a minute , 4) Gave me skills to use , 5) You can do this without being overwhelmed , and 6) We connected. The themes were organized in a pictorial representation of their interactions.
Conclusions: This study found that the CE-CERT program taught skills and concepts to our sample of attending physicians that were applicable and promoted self-motivation with potential to mitigate burnout and promote compassion satisfaction and professional quality of life.
Introduction:
Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically.
Purpose:
To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists.
Methods:
This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation.
Results:
Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations.
Conclusions:
The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.
The topic of physician burnout is not new, with the COVID-19 pandemic putting further strain on healthcare professionals. Surgeons are particularly susceptible because of extended training, long working hours, ingrained hierarchy, and years of practice in silent suffering. Data suggest that burnout is present in over 50 per cent of practising surgeons and 69 per cent of general surgery residents1–3. The personal and professional costs of burnout are thus significant4,5.
Surgeons are not good at recognizing burnout in themselves⁶. This is likely due to their indoctrination in the ‘hidden curriculum,’ which demands surgeons to avoid signs of weakness by eschewing whining, submitting blindly to authority, and prioritizing patient needs above all others⁷. As these behaviours become normalized, surgeons eventually lose the ability to gauge their stress until it is too late.
Beyond training, there is an escalation of administrative demands without an equal expansion of time, resources, and compensation. According to a recent survey⁸, the top drivers of physician burnout are excessive administrative tasks, followed by the amount of time spent at work, and lack of respect from administrators, colleagues, and staff. These tasks slowly seep into home life by means of e-mail, completion of records, and telephone calls. Physicians have little power to decline this administrative creep.
Objective. The objective of this pilot study is to evaluate the attitudes and self-efficacy of Advanced Pharmacy Practice Experience (APPE) Conference Leaders (CLs) after completing the Well-being Promotion (WelPro) training program developed at the University of California, San Francisco (UCSF) School of Pharmacy.Methods. The WelPro training program was developed to equip CLs with the knowledge and tools to assist APPE students in distress and promote student wellness. After completing the WelPro training program, a 20-item survey was administered to ten CLs via a web-based survey tool Qualtrics (Qualtrics, Provo, UT) to assess their attitudes about burnout and self-efficacy in Assisting Students in Distress (ASD). Descriptive statistics were used to characterize attitudes and self-efficacy; Wilcoxon signed-rank and Mann-Whitney U tests were used for non-parametric ordinal data.Results. Ten CLs participated in the training program. Nine CLs reported experiencing burnout in their careers and all believed burnout within the pharmacy profession could be avoidable. Confidence levels of CLs, after the WelPro training program, significantly improved in the following areas: identification of students in distress, identification of resources for students, and recognition of when and how to refer students in distress.Conclusion. Increased self-efficacy of CLs to identify and assist students in distress could be translated into their improved ability to support students' overall well-being. The WelPro training program can serve as a model for similar wellness training programs that directors and preceptors in experiential education can implement at their institutions.
Physician fatigue, also known as burnout, is a highly prevalent but often underrecognized result of workplace stressors. The consequences of burnout can include poor work-life integration, isolation, depression, and suicide. As a result, an organization may experience high physician turnover, patient safety issues, malpractice suits, and financial losses. Physicians should be encouraged to play a role in their wellness by taking mental time away from work, pursuing hobbies, attending wellness programs, and ensuring quality time with family. Ultimately, it is an organization that must acknowledge physician burnout, identify risk factors, and invest in targeted interventions to prevent this immense threat to their stability.
Oral and maxillofacial surgeons experience high levels of stress and work-home conflict, which predispose them to burnout. There is emerging evidence in support of work-life integration to prevent burnout; interventional strategies exist on an individual and organizational level. This article explores the current evidence on promoting work-life integration for improved surgeon satisfaction, performance, and efficiency. Work-life integration initiatives can help promote the recruitment and retention of a diverse surgical workforce in oral and maxillofacial surgery.
Introduction
Information regarding burnout in academic oral and maxillofacial surgeons (OMSs) in the United States (US) does not exist. The purpose of this project was to answer the following question: “Does burnout exist in academic OMSs in the United States?”
Materials and Methods
A fifteen-question anonymous survey was created based on Expanded Physician Well-Being Index (WBI, MedEd Web Solutions). Survey was sent electronically to fellows of the American Academy of Craniomaxillofacial Surgeons (AACMS) consisting of demographics, professional obligations, wellness indicators (burnout, emotional hardening, depression, anxiety, fatigue, overwhelmed), and overall quality of life statements. Responses were quantified according to a scaled scoring system specific for WBI. Multivariable logistic regression was then used to create a predictive model of being “at risk” of burnout.
Results
Surveys were sent to 180 active AACMS fellows; 110 completed the questionnaire (61.1%). 108 active fellows met inclusion criteria. Majority were males between the ages of 41 and 50. About a quarter spent more than 20 years in an academic setting. Activities concentrated on patient care, teaching, and/or administrative duties. More than half of respondents felt emotionally hardened, anxious/irritable, and/or overwhelmed. About a third had adequate time for personal and family life. Most felt that their work was meaningful.
Using WBI, the average score was 2.21, meaning that as a whole OMS academics are not considered “at risk” for burnout. Risk factors for burnout were age >40 years old, female gender, patient care more than 55 hours per week, call more than 10 times per month, and majority of time spent on teaching responsibilities.
Conclusions
According to WBI, OMSs as a group are not at risk for burnout. Certain traits (age, gender, more than 55 weekly hours and/or more than 10 call shifts per month, high percentage of time teaching responsibilities) are at higher risk for burnout.
Over the past decades, advances in surgical robotics have led to significant improvements in the care provided to women with gynecologic cancer. These advancements have occurred during a time when healthcare systems are changing their focus from a traditional fee for service model to value-based healthcare. The focus on value and risk sharing has led to institutions choosing quality outcomes over complications. This has been emphasized from the recent addition of the Institute for Healthcare Improvement modification of the Triple AIM to the Quadruple Aim: better care, better quality, better cost, and better experience. The added focus on better experience includes the patient and healthcare professional. This comes at an important time in medicine, where the implementation of electronic medical records (EMRs) such as Epic and Cerner has been met with a significant increase in physician burnout.
Unlabelled:
Through a systematic review and mixed-methods meta-synthesis of the existing literature on surgeon well-being, we sought to identify the specific elements of surgeon well-being, examine factors associated with suboptimal well-being, and highlight opportunities to promote well-being.
Background:
Suboptimal surgeon well-being has lasting and substantial impacts to the individual surgeon, patients, and to society as a whole. However, most of the existing literature focuses on only 1 aspect of well-being-burnout. While undoubtedly a crucial component of overall well-being, the mere absence of burnout does not fully consider the complexities of being a surgeon.
Methods:
We performed a literature search within Ovid Medline, Elsevier Excerpta Medica dataBASE, EBSCOhost Cumulative Index to Nursing and Allied Health Literature, and Clarivate Web of Science from inception to May 7, 2020, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with primary data examining surgeon well-being were included. Using a predetermined instrument, data were abstracted from each study and compared using thematic analysis.
Results:
A total of 5369 abstracts were identified and screened, with 184 full articles (172 quantitative, 3 qualitative, 9 mixed methods) selected for analysis. Among these, 91 articles measured burnout, 82 examined career satisfaction, 95 examined work-related stressors, 44 explored relationships and families, and 85 assessed emotional and physical health. Thematic analysis revealed 4 themes: professional components, personal components, work-life balance, and impacts to well-being.
Conclusions:
Surgeon well-being is complex and multifaceted. This nuanced examination of surgeon well-being highlights the critical need to develop and provide more long-term support to surgeons-with interventions being tailored based on individual, institutional, and systemic factors.
Objective
Identify current pharmacy residents’ level of distress, likelihood of burnout, likelihood of severe fatigue, suicidal ideation, meaning in work, satisfaction with work-life balance and overall quality of life.
Study Design
A cross-sectional survey, conducted between February 1, 2020 – March 31, 2020.
Methods
The Pharmacist WBI was utilized to collect data from first- and second-year pharmacy resident participants. A survey was sent to each Residency Program Director (RPD) listed in the American Society of Health System Pharmacist directory. RPDs were asked to forward the email with information on the survey for the residents to complete. The email contained a description of the research project and a link to the research survey. Respondents were asked to complete questions regarding their demographics in the research survey, including age, gender, ethnicity, marital status, commute time, type of residency, year of residency, etc. They were then asked to complete the WBI via the provided link and asked to enter their results from the WBI into the survey.
Results
Pharmacy residents are at high risk for developing burnout;53% of participants were considered to be “high risk”. Approximately 43% of pharmacy residents were considered to have a moderate to high risk for developing severe fatigue and 57% had poor work-life integration scores. Participants were found to have a high quality of life and high meaning in their work, 46% and 62% respectively.
Conclusions
The study identified that pharmacy residents’ experience great levels of distress, are more likely to experience symptoms of burnout, and more likely to experience fatigue. Pharmacy residents also experience a high quality of life and high meaning in their work.
Purpose:
To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools.
Method:
In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies.
Results:
Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools the mean FTE support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24, P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barriers to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84).
Conclusions:
Wellness programs are widely established at U.S. and Canadian medical schools and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students' well-being and success.
Physician burnout and healthcare worker stress are well covered topics in both the medical and lay press. Burnout in physicians can start as early as medical school. Well-being initiatives, programming, and access to support for all medical professionals are of paramount importance. In 2014 the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Resident/Fellow Education in Anesthesiology added Professionalism as a milestone. A subcategory of Professionalism includes: A responsibility to maintain personal, emotional, physical, and mental health.This subcategory charges all residency and fellowship programs with establishing a curriculum in well-being. The development, execution, and evaluation of these programs are left to the individual institutions. In this paper the development, processes and preliminary outcomes of a resident well-being curriculum are presented.
Objective:
To assess the prevalence of distress and burnout in otolaryngology trainees, including associations with relevant sociodemographic and professional factors, and to compare these results with those of attending otolaryngologists.
Study design:
A cross-sectional survey of trainees and attending physicians.
Setting:
Twelve academic otolaryngology programs.
Methods:
Distress and burnout were measured with the Expanded Physician Well-being Index and the 2-item Maslach Burnout Inventory. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen for depressive disorders and anxiety disorders, respectively. Associations with sociodemographic and professional characteristics were assessed.
Results:
Of the 613 surveys administered to trainees and attending physicians, 340 were completed (56%). Among 154 trainees, distress was present in 49%, professional burnout in 35%, positive depressive disorder screening in 5%, and positive anxiety disorder screening in 16%. In univariable analysis, female gender, hours worked in a typical week (HW), and nights on call in a typical week (NOC) were significantly associated with distress. In multivariable analysis, female gender (odds ratio, 3.91; P = .001) and HW (odds ratio for each 10 HW, 1.89; P = .003) remained significantly associated with distress. Female gender, HW, and NOC were significantly associated with burnout univariably, although only HW (odds ratio for each 10 HW, 1.92; P = .003) remained significantly associated with burnout in a multivariable setting. Attending physicians had less distress than trainees (P = .02) and felt less callous and less emotionally hardened than trainees (P < .001).
Conclusion:
Otolaryngology trainees experience significant work-place distress (49%) and burnout (35%). Gender, HW, and NOC had the strongest associations with distress and burnout.
Background
Well-being and distress are important issues in the pharmacist workforce; yet, there is limited evidence evaluating the validity of practical screening tools among pharmacists.
Objectives
To evaluate the ability of the Well-Being Index (WBI) to (1) identify the well-being and dimensions of distress in pharmacists, and (2) stratify pharmacists’ likelihood of adverse professional consequences.
Methods
In July 2019, a national sample of pharmacists completed the Web-based version of the 9-item WBI (score range −2 to 9) and standardized instruments to assess quality of life (QOL), fatigue, burnout, concern for a recent major medication error, and intent to leave the current job. The Fisher exact test or chi-square test was used, as appropriate, to obtain the univariate odds ratio, posttest probabilities, and likelihood ratios associated with the WBI score for each outcome.
Results
A total of 2231 pharmacists completed the survey. The most common practice settings were community pharmacies—chain (36.7%) and independent (10.7%)—followed by hospitals or health systems (20.1%) and academia (11.7%). The mean overall WBI score was 3.3 ± 2.73 (mean ± SD). Low QOL, extreme fatigue, and burnout symptoms were present in 34.8%, 35.3%, and 59.1%, respectively, of the responders. As the WBI score increased, the odds for low QOL, fatigue, burnout, concern for a recent major medication error, and intent to leave the current position increased incrementally. The WBI score also stratified the odds of high QOL. Assuming a pretest burnout probability of 59.1% (prevalence of the overall sample), the WBI lowered the posttest probability to 2% or raised it to 98% with an area under the receiver operating characteristic curve of 0.87.
Conclusion
The WBI may serve as a useful tool to gauge well-being and to identify pharmacists who may be experiencing important dimensions of distress and have increased risk for adverse professional consequences.
For physicians, the early career phase spans medical training (medical school, residency, fellowship) through the initial years of post-training employment. While the transition out of the trainee role marks an important inflection point, this period is unified by a focus on developing knowledge, clinical skills, and scope of practice and by establishing greater professional authority and identity. Several issues may uniquely affect the risk for burnout in women during this phase, including the realities of negotiating work obligations with the demands of relationship-, community-, and family-building which are common during this chronological and developmental timeframe. Issues related to reproduction are often salient. Productivity expectations—particularly those established in academic settings within a historical context that was male-dominated—may need adjustment to account for these factors. Additionally, the evolution of authority that must occur during this phase can be impacted by gendered expectations of performance in the workplace. This chapter proposes both individual and organizational solutions to prevent and manage burnout in women during this critical early phase of career development. To organize these solutions, we utilize the Stanford School of Medicine wellness framework which conceptualizes three major domains that impact wellness: Culture, Efficiency of Practice, and Resiliency.
Introduction
Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe.
Materials and Methods
Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software.
Results
A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4 ± 3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume <1 portions of fruit/day and more than half (52%) eat <1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6 h/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30 min twice weekly was only performed by 33% of the respondents.
Conclusions
Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.
Introduction:
Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe.
Materials and methods:
Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software.
Results:
A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4±3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume<1 portions of fruit/day and more than half (52%) eat<1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6hours/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30min twice weekly was only performed by 33% of the respondents.
Conclusions:
Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.
Objective:
To monitor demographics and factors associated with quality of life among obstetrics and gynecology clerkship directors. A secondary goal was to compare current demographics and survey responses to a 1994 survey of clerkship directors.
Methods:
A 36-item electronic survey was developed and distributed to the 182 U.S. clerkship directors with active memberships with the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, attitudes about being a clerkship director, quality of life, and burnout.
Results:
A total of 113 of the 182 (62%) clerkship directors responded to the survey. The mean full-time time equivalent allocated for clerkship director responsibilities was 25%. When compared with clerkship directors from 1994, current clerkship directors are younger, work fewer total hours per week, spend more time on patient care, and less time on research. Notably, 78% (87) of respondents were female compared with 21% (31) of respondents in 1994. Overall, most current clerkship directors responded optimistically to quality of life and burnout measures, with 25% (28) reporting symptoms of high emotional exhaustion and 17% (19) reporting symptoms of depersonalization. Clerkship directors' perception of support from their medical school was significantly correlated with increased personal fulfilment and positive quality of life, as well as decreased burnout and emotional exhaustion measures.
Conclusion:
The gender demographics of obstetrics and gynecology undergraduate medical education leadership have dramatically shifted over the past 25 years; however, many of the changes are not correlated with quality of life and burnout. The association between perceived support from the medical school and multiple quality of life measures point to the vital importance of support for our medical educators.
Ce n’est pas une coïncidence si l'accident nucléaire de Three Mile Island, la marée noire de l'Exxon Valdez, l’accident chimique de Bhopal ou la catastrophe de Tchernobyl se sont tous déroulés en pleine nuit. Chacune de ces catastrophes est le symptôme d’une société qui s’est affranchie des contraintes circadiennes. L’activité humaine n’est plus rythmée par l’immuable circonvolution de la Terre autour du Soleil, mais obéit aux impératifs logistiques essentiellement dictés par la doctrine économique. La diversité des rythmes de travail entre alors en contradiction avec la constance du rythme interne généré par l’horloge biologique. Ce décalage se manifeste par des difficultés d’endormissement, un sommeil moins réparateur ainsi qu’une sensation de somnolence qui persiste pendant la journée.
De ce point de vue, certaines professions sont plus à risque que d’autres. Il s’agit non seulement des secteurs où les horaires sont prestés de nuit, mais également des métiers où le temps de travail peut être excessif. C’est notamment le cas du secteur médical et plus particulièrement des services d’urgence dont l’engorgement n’a cessé de croître ces vingt dernières années. En Europe, les médecins urgentistes sont amenés à travailler jusqu’à 72 heures par semaine et 24 heures par jour pour assurer la continuité des soins. Des patients stressés, choqués, une grande variété de pathologies et une forte pression temporelle en font un environnement à très haut risque, presque chaotique, avec de nombreuses sources de fatigue cognitive et psychologique. La littérature expérimentale s’accorde à reconnaître que la fatigue entraîne une détérioration des performances physiques et cognitives. En revanche, les résultats sont plus équivoques en ce qui concerne son impact sur la qualité des soins en médecine d’urgence.
Certains auteurs suggèrent que l’absence de relation claire et systématique entre fatigue et performance médicale trouverait son origine dans l’existence de mécanismes de résilience visant à réduire ou à mitiger le risque associé à la fatigue. Ces mécanismes se développeraient notamment sous la forme de stratégies informelles et se transmettraient ensuite à travers des pratiques de mentorat non documentées. A ce jour, très peu d’attention a été accordée à l’étude de ces stratégies et il n’existe pas d’éléments empiriques permettant de juger de leur efficacité. Ainsi, l’hypothèse selon laquelle l’absence de relation systématique entre fatigue et performance serait liée à l’existence de mécanismes individuels de résilience reste à démontrer.
Dans ce contexte, notre travail vise à développer une méthodologie permettant l’identification et l’évaluation des stratégies informelles de gestion du risque associé à la fatigue déployées au niveau local et, plus largement, à proposer un modèle explicatif plus satisfaisant des liens entre fatigue et performance dans la gestion de situations d’urgence médicale.
If we believe that healthcare and our health systems are important, then we need to pay attention to the wellbeing and engagement of healthcare professionals. The work of health professionals drives all the clinical- and health-related processes in our health systems. If our healthcare professionals cannot consistently perform well, organizational leadership is not paying enough attention to the human factors in productivity, safety, and quality.
Background and purpose:
To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover.
Methods:
A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job.
Conclusions:
Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job.
Implications for practice:
The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.
Objectives
This prospective study explores the prevalence, associated characteristics, and trajectory of burnout over one academic year in a multidisciplinary sample of resident physicians using a relatively new burnout survey instrument.
Methods
All residents from a U.S. academic health center (n = 633) were invited to complete the Copenhagen Burnout Inventory (CBI) three times, with 4-month time lags between invitations. A total of 281 (44%) provided complete CBI survey responses at least once, and 43 (7%) did at all three times. Descriptive statistics, cross-sectional analyses, correlations, and multivariable linear regression analyses were computed, as well as repeated measures ANOVAs and paired t tests, as appropriate, for each CBI domain (personal, work, patient-related burnout).
Results
About half had CBI scores indicating moderate-to-high levels of personal burnout (49–52%) and work-related burnout (45–49%), whereas patient-related burnout was less common (14–24%). However, patient-related burnout increased significantly from the beginning to the end of the year. Regression analyses indicated patient-related burnout was significantly higher for postgraduate year 1–2 residents compared to PGY 4+ residents, but was not significantly different by gender. Personal and work burnout scores were significantly higher for females. Persistently high burnout was observed in only 6% of respondents.
Conclusions
In this study of resident physicians using the CBI, burnout was prevalent and higher levels of burnout were observed for females on the personal and work burnout domains, while junior residents had higher patient-related burnout. Persistently, high burnout was rare. The CBI demonstrated high reliability, was practical to administer, and produced similar results with existing burnout research.
This study examines the feasibility and effectiveness of a Mind-Body Skills training (MBST) curriculum in promoting physician compassion and mindfulness, and reducing stress and burnout. Participants were offered up to 7 hours of training: four free online modules on MBST and three interactive discussion sessions. Primary outcomes included feasibility and improvements in mindfulness and compassion. Of the 66 participants, 50 (76%) completed pre- and post-intervention questionnaires. Most (62%) completed at least one of seven hours of training. Compared with participants who used zero hours of training, those who completed at least one hour of training had significant mean differences in compassion (p = 0.05), burnout (p = 0.05), and emotional exhaustion (p < 0.01). These findings suggest that even brief Mind-Body Skills training curriculum for physicians is feasible, and is observed to be associated with improvements in compassion and reductions in burnout.
The 2018 radiology Intersociety Committee reviewed the current state of stress and burnout in our workplaces and identified approaches for fostering engagement, wellness, and job satisfaction. In addition to emphasizing the importance of personal wellness (the fourth aim of health care), the major focus of the meeting was to identify strategies and themes to mitigate the frequency, manifestations, and impact of stress. Strategies include reducing the stigma of burnout, minimizing isolation through community building and fostering connectivity, utilizing data and benchmarking to guide effectiveness of improvement efforts, resourcing and training “wellness” committees, acknowledging value contributions of team members, and improving efficiency in the workplace. Four themes were identified to prioritize organizational efforts: (1)collecting, analyzing, and benchmarking data; (2)developing effective leadership; (3)building high-functioning teams; and (4)amplifying our voice to increase our influence.
Background:
Studies suggest there is a high prevalence of burnout and depression among U.S. nurses.
Objectives:
To gauge the capability of the Well-Being Index (WBI) to stratify nurse distress (e.g., low quality of life [QOL], extreme fatigue, burnout, recent suicidal ideation) and well-being (high quality of life), and detect those whose level of distress may negatively affect retention or work performance METHODS: In 2016, we conducted a cross-sectional survey of 3,147 U.S. nurses. The survey included the WBI and standard instruments to assess overall QOL, fatigue, burnout, recent suicidal ideation, patient-care errors, and intent to leave current job. We used Fisher exact test and Wilcoxon/2-sample t-test procedures with a 5% type I error rate and a two-sided alternative.
Results:
Of the 812 (26%) nurses who completed the survey, 637 were eligible for the present analysis. Nurses with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had a higher total score (all P < .001) resulting in less favorable WBI scores. With a 17% pretest probability of low overall QOL, the WBI score can decrease the posttest probability of low QOL to 2% or increase it to 72%. The likelihood of high overall QOL decreased in a stepwise fashion from 3.38 to 0.04 as the WBI score increased. WBI score also stratified nurses' likelihood of reporting a recent patient-care error and/or intent to leave current job.The WBI is a useful screening tool to stratify both distress and well-being across a variety of domains in nurses and identify those nurses whose severity of distress may negatively affect patient care and retention.
Burnout is characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. There are both personal and professional consequences of physician burnout. Increasing evidence suggests that physician burnout can adversely affect patient safety and quality of patient care and even contribute to medical errors and, furthermore, that the organizational and practice environment has an important critical role in whether physicians remain engaged or burned out. Most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Extensive research now indicates the well-being and professional satisfaction of physicians have a profound effect on their quality of care and patient adherence with treatment recommendations and satisfaction with medical care. Therefore, there is both a moral and ethical imperative to address physician burnout. In addition, there is a strong professional and business case to reduce physician burnout and promote physician engagement. The leadership qualities of physician supervisors also impact the personal well-being of the physicians they lead in their healthcare organization. The Mayo Clinic experience has demonstrated that sustained and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Mentorship has also been recognized as a key element of career satisfaction because it has a very important influence on career guidance, physician productivity, and personal development. Although it is important for all surgeons to address the issues of personal wellness, it is particularly important for those who are at increased risk based on combinations of high workload, specific surgical specialty, practice environment, age, family responsibilities, and work-home conflict resolution that, in the aggregate, span a spectrum of risk for burnout, depression, and lower mental quality of life. Physicians must be guided from the earliest years of training to cultivate methods of personal renewal, emotional self-awareness, connection with social support systems, and a sense of mastery and meaning in their workplace practice environment.
How multiple forms of psychological distress coexist in individual medical students has not been formally studied.
To explore the prevalence of various forms of distress in medical students and their relationship to recent suicidal ideation or serious thoughts of dropping out of school.
All medical students at seven US schools were surveyed with standardized instruments to evaluate burnout, depression, stress, mental quality of life (QOL), physical QOL, and fatigue. Additional items explored recent suicidal ideation and serious thoughts of dropping out of medical school.
Nearly all (1846/2246, 82%) of medical students had at least one form of distress with 1066 (58%) having ≥3 forms of distress. A dose-response relationship was found between the number of manifestations of distress and recent suicidal ideation or serious thoughts of dropping out. For example, students with 2, 4, or 6 forms of distress were 5, 15, and 24 fold, respectively, more likely to have suicidal ideation than students with no forms of distress assessed. All forms of distress were independently associated with suicidal ideation or serious thoughts of dropping out on multivariable analysis.
Most medical students experience ≥1 manifestation of distress with many experiencing multiple forms of distress simultaneously. The more forms of distress experienced the greater the risk for suicidal ideation and thoughts of dropping out of medical school.
Psychological distress is common among medical students but manifests in a variety of forms. Currently, no brief, practical tool exists to simultaneously evaluate these domains of distress among medical students. The authors describe the development of a subject-reported assessment (Medical Student Well-Being Index, MSWBI) intended to screen for medical student distress across a variety of domains and examine its preliminary psychometric properties.
Relevant domains of distress were identified, items generated, and a screening instrument formed using a process of literature review, nominal group technique, input from deans and medical students, and correlation analysis from previously administered assessments. Eleven experts judged the clarity, relevance, and representativeness of the items. A Content Validity Index (CVI) was calculated. Interrater agreement was assessed using pair-wise percent agreement adjusted for chance agreement. Data from 2248 medical students who completed the MSWBI along with validated full-length instruments assessing domains of interest was used to calculate reliability and explore internal structure validity.
Burnout (emotional exhaustion and depersonalization), depression, mental quality of life (QOL), physical QOL, stress, and fatigue were domains identified for inclusion in the MSWBI. Six of 7 items received item CVI-relevance and CVI-representativeness of >or=0.82. Overall scale CVI-relevance and CVI-representativeness was 0.94 and 0.91. Overall pair-wise percent agreement between raters was >or=85% for clarity, relevance, and representativeness. Cronbach's alpha was 0.68. Item by item percent pair-wise agreements and Phi were low, suggesting little overlap between items. The majority of MSWBI items had a >or=74% sensitivity and specificity for detecting distress within the intended domain.
The results of this study provide evidence of reliability and content-related validity of the MSWBI. Further research is needed to assess remaining psychometric properties and establish scores for which intervention is warranted.
Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown.
To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale.
Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures.
The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P < .001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P < .001; emotional exhaustion OR, 1.06; 95% CI, 1.04-1.08; P < .001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P < .001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72; P < .001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P < .001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression.
Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.
The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to data have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stage-matched programs is the similarity between participants reactively recruited who reached us for help and those proactively recruited who we reached out to help. If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.
To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.
An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.
The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.
This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.
The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.
Despite the importance of diversity of cancer trial participants with regard to race, ethnicity, age, and sex, there is little recent information about the representation of these groups in clinical trials.
To characterize the representation of racial and ethnic minorities, the elderly, and women in cancer trials sponsored by the National Cancer Institute.
Cross-sectional population-based analysis of all participants in therapeutic nonsurgical National Cancer Institute Clinical Trial Cooperative Group breast, colorectal, lung, and prostate cancer clinical trials in 2000 through 2002. In a separate analysis, the ethnic distribution of patients enrolled in 2000 through 2002 was compared with those enrolled in 1996 through 1998, using logistic regression models to estimate the relative risk ratio of enrollment for racial and ethnic minorities to that of white patients during these time periods.
Enrollment fraction, defined as the number of trial enrollees divided by the estimated US cancer cases in each race and age subgroup.
Cancer research participation varied significantly across racial/ethnic and age groups. Compared with a 1.8% enrollment fraction among white patients, lower enrollment fractions were noted in Hispanic (1.3%; odds ratio [OR] vs whites, 0.72; 95% confidence interval [CI], 0.68-0.77; P<.001) and black (1.3%; OR, 0.71; 95% CI, 0.68-0.74; P<.001) patients. There was a strong relationship between age and enrollment fraction, with trial participants 30 to 64 years of age representing 3.0% of incident cancer patients in that age group, in comparison to 1.3% of 65- to 74-year-old patients and 0.5% of patients 75 years of age and older. This inverse relationship between age and trial enrollment fraction was consistent across racial and ethnic groups. Although the total number of trial participants increased during our study period, the representation of racial and ethnic minorities decreased. In comparison to whites, after adjusting for age, cancer type, and sex, patients enrolled in 2000 through 2002 were 24% less likely to be black (adjusted relative risk ratio, 0.76; 95% CI, 0.65-0.89; P<.001). Men were more likely than women to enroll in colorectal cancer trials (enrollment fractions: 2.1% vs 1.6%, respectively; OR, 1.30; 95% CI, 1.24-1.35; P<.001) and lung cancer trials (enrollment fractions: 0.9% vs 0.7%, respectively; OR, 1.23; 95% CI, 1.16-1.31; P<.001).
Enrollment in cancer trials is low for all patient groups. Racial and ethnic minorities, women, and the elderly were less likely to enroll in cooperative group cancer trials than were whites, men, and younger patients, respectively. The proportion of trial participants who are black has declined in recent years.
Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.
To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.
Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.
Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).
Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
Purpose
To investigate the level of burnout in the oncology community in the United States.
Patients and Methods
Seven thousand seven hundred fifteen oncology physicians were queried by e-mail or during attendance at oncologic meetings and asked to complete a 22-question survey concerning their feelings of personal burnout and their perceptions of physician burnout in the oncology community. The data were analyzed using standard statistical methods including a multivariate analyses using logistic regression with stepwise selection.
Results
One thousand seven hundred forty oncologists (22.6%) completed and returned the survey, with 92.6 % representing medical oncologists or hematologist-oncologists. Two thirds of the respondents were from community practice and one third from academia. Overall, 61.7% of the respondents reported feelings of burnout, with the top three signs being frustration (78%), emotional exhaustion (69%), and lack of satisfaction with their work (50%). The highest-ranked causes for their feelings of burnout included overwork, lack of time away from the office, and reimbursement concerns. The top remedies for burnout were felt to be fewer patients, more time away from the office, and increased attendance at medical meetings. The multivariate analyses demonstrated highly significant associations between burnout and hours spent on patient care, personal time off, and number of educational meetings attended.
Conclusion
The rate of burnout in the oncology community of the United States exceeds 60%. This report suggests causes and potential solutions for the high rate of burnout. Such information may lead to an improved understanding of the needed steps to improve the quality of life for the oncology community with the ultimate goal of further improving patient care. Patients deserve optimal medical and emotional support that is best provided by caring and well-informed practitioners.
Background: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care. Objective: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices. Design: Cross-sectional study using an anonymous, mailed survey. Setting: University-based residency program in Seattle, Washington. Participants: 115 internal medicine residents. Measurements: Burnout was measured by using the Maslach Burnout Inventory and was defined as scores in the high range for medical professionals on the depersonalization or emotional exhaustion subscales. Five questions developed for this study assessed self-reported patient care practices that suggested suboptimal care (for example, I did not fully discuss treatment options or answer a patient's questions or I made … errors that were not due to a lack of knowledge or inexperience). Depression and at-risk alcohol use were assessed by using validated screening questionnaires. Results: Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout. Compared with non-bumed-out residents, burned-out residents were significantly more likely to self-report providing at least one type of suboptimal patient care at least monthly (53% vs. 21%; P = 0.004). In multivariate analyses, burnout-but not sex, depression, or at-risk alcohol use-was strongly associated with self-report of one or more suboptimal patient care practices at least monthly (odds ratio, 8.3 [95% Cl, 2.6 to 26.5]). When each domain of burnout was evaluated separately, only a high score for depersonalization was associated with self-reported suboptimal patient care practices (in a dose-response relationship). Conclusion: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.
Background:
Despite a high prevalence of distress, few physicians seek help. Earlier identification of physicians in distress has been hampered by the lack of a brief screening instrument to assess the common forms of distress.
Objective:
To evaluate the ability of the seven-item Physician Well-Being Index (PWBI) to i) stratify physician well-being in several important dimensions (mental quality of life [QOL], fatigue, suicidal ideation); and ii) identify physicians whose degree of distress may negatively impact their practice (career satisfaction, intent to leave current position, medical errors).
Design:
Cross-sectional study.
Participants:
National sample of 6,994 U.S. physicians.
Main measures:
PWBI, Mental QOL, fatigue, suicidal ideation, career satisfaction,and clinical practice measures.
Key results:
Physicians with low mental QOL, high fatigue, or recent (< 12 months) suicidal ideation were more likely to endorse each of the seven PWBI items and a greater number of total items (all P < 0 .001). Assuming a prevalence of 19 %, the PWBI could reduce the post-test probability of a physician having low mental QOL to < 1 % or raise it to > 75 %. The likelihood ratio for low mental QOL among physicians with PWBI scores ≥ 4 was 3.85 in comparison to 0.33 for those with scores < 4. At a threshold score of >4, the PWBI's specificity for identifying physicians with low mental QOL, high fatigue, or recent suicidal ideation were 85.8 %. PWBI score also stratified physicians' career satisfaction, reported intent to leave current practice, and self-reported medical errors.
Conclusions:
The seven-item PWBI appears to be a useful screening index to identify physicians with distress in a variety of dimensions and whose degree of distress may negatively impact their practice.
Background:
Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields.
Methods:
We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored.
Results:
Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout.
Conclusions:
Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.
To evaluate the health habits, routine medical care practices, and personal wellness strategies of American surgeons and explore associations with burnout and quality of life (QOL).
Burnout and low mental QOL are common among US surgeons and seem to adversely affect quality of care, job satisfaction, career longevity, and risk of suicide. The self-care strategies and personal wellness promotion practices used by surgeons to deal with the stress of practice are not well explored.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in October 2010. The survey included self-assessment of health habits, routine medical care practices, and personal wellness strategies and standardized assessments of burnout and QOL.
Of 7197 participating surgeons, 3911 (55.0%) participated in aerobic exercise and 2611 (36.3%) in muscle strengthening activities, in a pattern consistent with the Centers for Disease Control and Prevention recommendations. The overall and physical QOL scores were superior for surgeons' following the Centers for Disease Control and Prevention recommendations (all P < 0.0001). A total of 3311 (46.2%) participating surgeons had seen their primary care provider in the last 12 months. Surgeons who had seen their primary care provider in the last 12 months were more likely to be up to date with all age-appropriate health care screening and had superior overall and physical QOL scores (all P < 0.0001). Ratings of the importance of 16 personal wellness promotion strategies differed for surgeons without burnout (all P < 0.0001). On multivariate analysis, surgeons placing greater emphasis on finding meaning in work, focusing on what is important in life, maintaining a positive outlook, and embracing a philosophy that stresses work/life balance were less likely to be burned out (all P < 0.0001). Although many factors associated with lower risk of burnout were also associated with achieving a high overall QOL, notable differences were observed, indicating surgeons' need to employ a broader repertoire of wellness promotion practices if they desire to move beyond neutral and achieve high well-being.
This study identifies specific measures surgeons can take to decrease burnout and improve their personal and professional QOL.
To determine the point prevalence of alcohol abuse and dependence among practicing surgeons.
Cross-sectional study with data gathered through a 2010 survey.
The United States of America.
Members of the American College of Surgeons.
Alcohol abuse and dependence.
Of 25,073 surgeons sampled, 7197 (28.7%) completed the survey. Of these, 1112 (15.4%) had a score on the Alcohol Use Disorders Identification Test, version C, consistent with alcohol abuse or dependence. The point prevalence for alcohol abuse or dependence for male surgeons was 13.9% and for female surgeons was 25.6%. Surgeons reporting a major medical error in the previous 3 months were more likely to have alcohol abuse or dependence (odds ratio, 1.45; P < .001). Surgeons who were burned out (odds ratio, 1.25; P = .01) and depressed (odds ratio, 1.48; P < .001) were more likely to have alcohol abuse or dependence. The emotional exhaustion and depersonalization domains of burnout were strongly associated with alcohol abuse or dependence. Male sex, having children, and working for the Department of Veterans Affairs were associated with a lower likelihood of alcohol abuse or dependence.
Alcohol abuse and dependence is a significant problem in US surgeons. Organizational approaches for the early identification of problematic alcohol consumption followed by intervention and treatment where indicated should be strongly supported.
We compared distress parameters and career satisfaction from survey results of surgeons from 14 specialties practicing in an academic versus private practice environment.
The 2008 American College of Surgeons survey evaluated demographic variables, practice characteristics, career satisfaction, and distress parameters using validated instruments.
The practice setting (academic vs. private practice) was independently associated with burnout in a multivariate (MV) analysis (odds ratio [OR] 1.172, P = 0.02). Academic surgeons were less likely to experience burnout compared to those in private practice (37.7% vs. 43.1%), less likely to screen positive for depression (27.6% vs. 33%) or to have suicide ideation (4.7% vs. 7.4%; all P < 0.0001). They were also more likely to have career satisfaction (77.4% of academic surgeons would become a surgeon again vs. 64.9% for those in private practice; P < 0.0001)) and to recommend a medical career to their children (61.3% vs. 43.7%, P < 0.0001). For academic surgeons, the most significant positive associations with burnout were: (1) trauma surgery (OR 1.513, P = 0.0059), (2) nights on call (OR 1.062, P = 0.0123), and (3) hours worked (OR 1.019, P < 0.0001), whereas the negative associations were: (1) having older children (>22 years; OR 0.529, P < 0.0001), (2) pediatric surgery (OR 0.583, P = 0.0053), (3) cardiothoracic surgery (OR 0.626, P = 0.0117), and (4) being male (OR 0.787, P = 0.0491). In a private practice setting, the most significant positive associations with burnout were: (1) urologic surgery (OR 1.497, P = 0.0086), (2) having 31% to 50% time for nonclinical activities (OR 1.404, P = 0.0409), (3) incentive based pay (OR 1.344, P < 0.0001), (4) nights on call (OR 1.045, P = 0.0029), and (5) hours worked (OR 1.015, P < 0.0001), whereas the negative associations were: (1) older children (OR 0.677, P = 0.0001), (2) physician spouse (OR 0.753, P = 0.0093), and (3) older age (OR 0.989, P = 0.0158). The independent factors relating to career satisfaction for surgeons in private practice and academic practice were also different.
Factors associated with burnout were distinct for academic and private practice surgeons. Distress parameters were lower and career satisfaction higher for academic surgeons.
Our objective was to identify the prevalence of recent malpractice litigation against American surgeons and evaluate associations with personal well-being. Although malpractice lawsuits are often filed against American surgeons, the personal consequences with respect to burnout, depression, and career satisfaction are poorly understood.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in October 2010. Surgeons were asked if they had been involved in a malpractice suit during 2 previous years. The survey also evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life.
Of the approximately 25,073 surgeons sampled, 7,164 (29%) returned surveys. Involvement in a recent malpractice suit was reported by 1,764 of 7,164 (24.6%) responding surgeons. Surgeons involved in a recent malpractice suit were younger, worked longer hours, had more night call, and were more likely to be in private practice (all p <0.0001). Recent malpractice suits were strongly related to burnout (p < 0.0001), depression (p < 0.0001), and recent thoughts of suicide (p < 0.0001) among surgeons. In multivariable modeling, both depression (odds ratio = 1.273; p = 0.0003) and burnout (odds ratio = 1.168; p = 0.0306) were independently associated with a recent malpractice suit after controlling for all other personal and professional characteristics. Hours worked, nights on call, subspecialty, and practice setting were also independently associated with recent malpractice suits. Surgeons who had experienced a recent malpractice suit reported less career satisfaction and were less likely to recommend a surgical or medical career to their children (p < 0.0001).
Malpractice lawsuits are common and have potentially profound personal consequences for US surgeons. Additional research is needed to identify individual, organizational, and societal interventions to support surgeons subjected to malpractice litigation.
Surgeons train for many years and work long hours, often dealing with stressful situations. As a result, some surgeons may experience burnout, which in some cases may lead to depression and/or drug dependency. Identifying and effectively managing causes of stress as well as determining the optimal work-life balance is critical for obtaining personal and professional career satisfaction. This article explores causes of surgeon burnout and reviews results from the American College of Surgeons Burnout Survey. Strategies for personal and professional growth, wellness and renewal are also discussed.
To determine whether the Medical Student Well-Being Index (MSWBI) can serve as a brief assessment tool to identify medical students in severe psychological distress.
The authors used data from 2,248 medical students at seven U.S. medical schools who responded to a 2007 survey to explore the accuracy of the MSWBI in identifying medical students with three outcomes: low mental quality of life (QOL; defined by having a Medical Outcomes Study Short-Form Health Survey mental component summary score ≥1/2 standard deviation below that of the age- and gender-matched population norm), suicidal ideation, or serious thoughts of dropping out. The authors confirmed their analyses using data from a separate sample of 2,682 students evaluated in 2009.
Students with low mental QOL, suicidal ideation, or serious thoughts of dropping out were more likely to endorse each individual MSWBI item and a greater number of total items than were students without such distress (all P < .001). The likelihood ratio for low mental QOL among students with MSWBI scores <4 was 0.47 as compared with 4.79 for those with scores ≥4. At an MSWBI threshold score of ≥4, the MSWBI's sensitivity and specificity for identifying students with low mental QOL or recent suicidal ideation/serious thoughts of dropping out were both ≥90%. On multivariable logistic regression, all MSWBI items were independently associated with at least one outcome.
The MSWBI is a useful brief screening tool to help identify students with severe distress.
Archives of Otolaryngology–Head and Neck SurgeryProfessional Burnout Among Microvascular and Reconstructive Free-Flap Head and Neck Surgeons in the United StatesStephanie P. Contag, BA; Justin S. Golub, MD; Theodoros N. Teknos, MD; Brian Nussenbaum, MD; Brendan C. Stack Jr, MD; David J. Arnold, MD; Michael M. Johns III, MD Objectives:
To determine the prevalence of professional burnout among microvascular free-flap (MVFF) head and neck surgeons and to identify modifiable risk factors with the intent to reduce MVFF surgeon burnout.Design:
A cross-sectional, observational study.Setting:
A questionnaire mailed to MVFF surgeons in the United States.Participants:
A total of 60 MVFF surgeons.Main Outcomes Measures:
Professional burnout was quantified using the Maslach Burnout Inventory–Human Services Study questionnaire, which defines burnout as the triad of high emotional exhaustion (EE), high depersonalization (DP), and low personal accomplishment. Additional data included demographic information and subjective assessment of professional stressors, satisfaction, self-efficacy, and support systems using Likert score scales. Potential risk factors for burnout were determined via significant association (P < .05) by Fisher exact tests and analyses of variance.Results:
Of the 141 mailed surveys, 72 were returned, for a response rate of 51%, and 60 of the respondents were practicing MVFF surgeons. Two percent of the responding MVFF surgeons experienced high burnout (n = 1); 73%, moderate burnout (n = 44); and 25%, low burnout (n = 15). Compared with other otolaryngology academic faculty and department chairs, MVFF surgeons had similar or lower levels of burnout. On average, MVFF surgeons had low to moderate EE and DP scores. High EE was associated with excess workload, inadequate administration time, work invading family life, inability to care for personal health, poor perception of control over professional life, and frequency of irritable behavior toward loved ones (P < .001). On average, MVFF surgeons experienced high personal accomplishment.Conclusions:
Most MVFF surgeons experience moderate professional burnout secondary to moderate EE and DP. This may be a problem of proper balance between professional obligations and personal life goals. Most MVFF surgeons, nonetheless, experience a high level of personal accomplishment in their profession.
To evaluate differences in burnout and career satisfaction between men and women surgeons and to determine the relationships among personal factors, professional characteristics, and work-home conflicts.
Cross-sectional study, with data gathered through a survey.
The United States.
Members of the American College of Surgeons.
Burnout and career satisfaction.
Of approximately 24,922 surgeons sampled, 1043 women and 6815 men returned surveys (31.5% response rate). Women surgeons were younger, less likely to be married, less likely to be divorced, and less likely to have children (all P < .001). No differences between women and men in hours worked or number of nights on call per week were observed. Women surgeons were more likely to believe that child-rearing had slowed their career advancement (57.3% vs 20.2%; P < .001), to have experienced a conflict with their spouse's/partner's career (52.6% vs 41.2%; P < .001), and to have experienced a work-home conflict in the past 3 weeks (62.2% vs 48.5%; P < .001). More women than men surgeons had burnout (43.3% vs 39.0%; P = .01) and depressive symptoms (33.0% vs 29.5%; P = .02). Factors independently associated with burnout on multivariate analysis were generally similar for men and women and included recent experience of a work-home conflict, resolving the most recent work-home conflict in favor of work, and hours worked per week.
Work-home conflicts appear to be a major contributor to surgeon burnout and are more common among women surgeons. Although the factors contributing to burnout were remarkably similar among women and men surgeons, the women were more likely to experience work-home conflicts than were their male colleagues.
Suicide is a disproportionate cause of death for US physicians. The prevalence of suicidal ideation (SI) among surgeons and their use of mental health resources are unknown.
Members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life.
Of 7905 participating surgeons (response rate, 31.7%), 501 (6.3%) reported SI during the previous 12 months. Among individuals 45 years and older, SI was 1.5 to 3.0 times more common among surgeons than the general population (P < .02). Only 130 surgeons (26.0%) with recent SI had sought psychiatric or psychologic help, while 301 (60.1%) were reluctant to seek help due to concern that it could affect their medical license. Recent SI had a large, statistically significant adverse relationship with all 3 domains of burnout (emotional exhaustion, depersonalization, and low personal accomplishment) and symptoms of depression. Burnout (odds ratio, 1.910; P < .001) and depression (odds ratio, 7.012; P < .001) were independently associated with SI after controlling for personal and professional characteristics. Other personal and professional characteristics also related to the prevalence of SI.
Although 1 of 16 surgeons reported SI in the previous year, few sought psychiatric or psychologic help. Recent SI among surgeons was strongly related to symptoms of depression and a surgeon's degree of burnout. Studies are needed to determine how to reduce SI among surgeons and how to eliminate barriers to their use of mental health resources.
Dual-physician relationships are increasingly common. In this study, the authors explore how surgeons in dual-physician relationships differ from other partnered surgeons in their demographics, practice characteristics, family lives, distress, and job satisfaction.
In 2008, members of the American College of Surgeons were asked to complete a survey that included questions on burnout, work-home conflict, and career satisfaction.
Among 7,905 responding surgeons (a 32% response rate), 7,120 (90%) had a domestic partner (DP). Half (3,471 of 7,120 [48.8%]) of DPs did not work outside the home, 16.4% (1,165) were physicians, and 34.9% (2,484) were working nonphysicians. Surgeons whose DP was a physician were younger, newer to practice, were more likely to delay having children and to believe childrearing had slowed their career advancement, and were less likely to believe that they had enough time for their personal and family life compared with their colleagues whose DP was a working nonphysician or stayed at home (all p < 0.05). Surgeons in dual-physician relationships more often experienced a recent career conflict with their DP and a work-home conflict than surgeons whose DPs were working nonphysicians (all p < 0.0001). Surgeons whose DP is another surgeon face even greater challenges in these areas. Physicians married or partnered to another physician were more likely to have depressive symptoms and low mental quality of life than surgeons whose DP stayed at home (all p < 0.05). Surgeons whose DP stayed at home appear to be more satisfied with their career (p = 0.0006).
Surgeons whose DP is another physicians appear to experience greater challenges balancing personal and professional life than surgeons whose DP is a working nonphysicians or whose DP stays at home.
Little is known regarding the rate of burnout, career satisfaction, and quality of life (QOL) among surgical oncologists compared with other surgical subspecialties.
The American College of Surgeons conducted a survey in 2008 involving 7,905 respondents, of whom 407 were surgical oncologists. Demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL) of surgical oncologists were compared with other surgical subspecialties using validated instruments.
Surgical oncologists were younger (mean age 49.9 years), more likely to be female (26%), and had younger children than other surgical subspecialties. With respect to practice characteristics, surgical oncologists had been in practice fewer years and had fewer nights on call per week than other surgical disciplines but worked more hours (mean 62.6/week), were more likely to be in an academic practice (59.5%), were more likely to be paid on a salaried basis (68%), and had more time devoted to non-patient activities (e.g., research). Compared with surgeons from all other specialties, surgical oncologists had similar incidence of burnout (36%), suicide ideation (4.9%), and QOL, but lower incidence of depression (24%), and better indices of career satisfaction.
These data provide a frame of reference for valid comparisons of burnout, QOL, and career satisfaction indices for the surgical oncology community relative to all other surgical specialties. Surgical oncologists have higher career satisfaction and lower risk of depression than surgeons in other surgical disciplines but still experience high rates of burnout.
The practice of surgery offers the potential for tremendous personal and professional satisfaction. Few careers provide the opportunity to have such a profound effect on the lives of others and to derive meaning from work. Surgeons choose this arduous task to change the lives of individuals facing serious health problems, to experience the joy of facilitating healing, and to help support those patients for whom medicine does not yet have curative treatments. Despite its virtues, a career in surgery brings with it significant challenges, which can lead to substantial personal distress for the individual surgeons and their family. By identifying the priorities of their personal and professional life, surgeons can identify values, choose the optimal practice type, manage the stressors unique to that career path, determine the optimal personal work-life balance, and nurture their personal wellness. Being proactive is better than reacting to burnout after it has damaged one's professional life or personal wellness. Studies like the ACS survey can benefit surgeons going through a personal crisis by helping them to know that they are not alone and that many of their colleagues face similar issues. It is important that surgeons do not make the mistake of thinking: "I must not be tough enough," or "no one could possibly experience what I am going through." The available evidence suggests that those surgeons most dedicated to their profession and their patient may very well be most susceptible to burnout. Silence on career distress, as a strategy, simply does not work among professionals whose careers, well-being, and level of patient care may be in jeopardy. Additional research in these areas is needed to elucidate evidence-based interventions to address physician distress at both the individual and organizational level to benefit the individual surgeon and the patient they care for. Surgeons must also be able to recognize how and when their personal distress affects the quality of care they provide (both in the delivery of care and in the emotional support of patients and their families). There is no single formula for achieving a satisfying career in surgery. All surgeons deal with stressful times in their personal and professional life and must cultivate habits of personal renewal, emotional self-awareness, connection with colleagues, adequate support systems, and the ability to find meaning in work to combat these challenges. As surgeons, we also need to set an example of good health to our patients and future generations of surgeons. To provide the best care for our patients, we need to be alert, interested in our work, and ready to provide for our patient's needs. Maintaining these values and healthy habits is the work of a lifetime.
To investigate the level of burnout in the oncology community in the United States.
Seven thousand seven hundred fifteen oncology physicians were queried by e-mail or during attendance at oncologic meetings and asked to complete a 22-question survey concerning their feelings of personal burnout and their perceptions of physician burnout in the oncology community. The data were analyzed using standard statistical methods including a multivariate analyses using logistic regression with stepwise selection.
One thousand seven hundred forty oncologists (22.6%) completed and returned the survey, with 92.6 % representing medical oncologists or hematologist-oncologists. Two thirds of the respondents were from community practice and one third from academia. Overall, 61.7% of the respondents reported feelings of burnout, with the top three signs being frustration (78%), emotional exhaustion (69%), and lack of satisfaction with their work (50%). The highest-ranked causes for their feelings of burnout included overwork, lack of time away from the office, and reimbursement concerns. The top remedies for burnout were felt to be fewer patients, more time away from the office, and increased attendance at medical meetings. The multivariate analyses demonstrated highly significant associations between burnout and hours spent on patient care, personal time off, and number of educational meetings attended.
The rate of burnout in the oncology community of the United States exceeds 60%. This report suggests causes and potential solutions for the high rate of burnout. Such information may lead to an improved understanding of the needed steps to improve the quality of life for the oncology community with the ultimate goal of further improving patient care. Patients deserve optimal medical and emotional support that is best provided by caring and well-informed practitioners.
The relationships of working hours and nights on call per week with various parameters of distress among practicing surgeons have not been previously examined in detail.
More than 7,900 members of the American College of Surgeons responded to an anonymous, cross-sectional survey. The survey included self-assessment of their practice setting, a validated depression screening tool, and standardized assessments of burnout and quality of life.
There was a clear gradient between hours and burnout, with the prevalence of burnout ranging from 30% for surgeons working <60 hours/week, 44% for 60 to 80 hours/week, and 50% for those working >80 hours/week (p < 0.001). When correlated with number of nights on call, burnout exhibited a threshold effect at ≥2 nights on call/week (≤1 nights on call/week, 30%; ≥2 nights on call/week, 44% to 46%; p < 0.0001). Screening positive for depression rate also correlated strongly with hours and nights on call (both p < 0.0001). Those who worked >80 hours/week reported a higher rate of medical errors compared with those who worked <60 hours/week (10.7% versus 6.9%; p < 0.001), and were twice as likely to attribute the error to burnout (20.1% versus 8.9%; p = 0.001). Not surprisingly, work and home conflicts were higher among surgeons who worked longer hours or had ≥2 nights on call. A significantly higher proportion of surgeons who worked >80 hours/week or had >2 nights on call/week would not become a surgeon again (p < 0.0001).
Number of hours worked and nights on call per week appear to have a substantial impact on surgeons, both professionally and personally. These factors are strongly related to burnout, depression, career satisfaction, and work and home conflicts.
To evaluate the relationship between burnout and perceived major medical errors among American surgeons.
Despite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL).
Of 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis.
Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.